#DiabetesDivide – How to Close The Gap

I’m at the airport, waiting to get on a flight to NYC for The Diabetes Divide: Cities, Inequality, and the Spread of The Disease event hosted by The Atlantic and underwritten by Novo Nordisk US and thoughts about the upcoming discussions have actually prevented me from sleeping soundly. Why? Because we have a divide and the solution to close the gap isn’t simple.

Here’s the description of the event:

Diabetes is a serious public health challenge: 29 million Americans have diabetes, and 86 million more are pre-diabetic. Worse, the disease disproportionately strikes racial minorities, and trends show that diabetes prevalence is growing at an alarming rate in urban areas. How do socioeconomic, racial and geographic factors shape how the epidemic is being addressed in urban communities — and perceived by the general public?

In a town hall event with community leaders, patients, public health experts and more, The Atlantic will consider the social determinants of diabetes, and what they require of the response.

The “patients” on the discussion surrounding Citizens and Diabetes are Kelly Close of Close Concerns and diaTribe and me. We’ve been paired with a physician from Mount Sinai and the VP of Healthy Lifestyles, YMCA New York. The topic will be moderated and truth? I have no idea how the conversation will unfold.

There is a divide. Culture, race, perceptions, health insurance, food deserts, and motivation all play a part in the rise of Type 2 diabetes. These are the questions that caused my insomnia:

How do you change a society that values convenience?

How do you entice someone making minimum wage to purchase “healthy” food choices when few restaurants and grocery stores offer them at a reasonable price?

How do you counter cultural pressures surrounding food? (Imagine a 45 year-old construction worker saying to his friends: “Hold on while I run into the bodega and grab a kale salad with chicken and an apple for lunch.”)

How do you test individuals for pre-diabetes when they can’t afford to go to a clinic?

How do you explain to the healthcare system that simply telling an individual to lose weight and get some exercise is not going to change behaviors?

How do you get someone to take time out of their lives to do diabetes education programs or diabetes prevention programs when they’re working two jobs to feed their family?

How do you tell someone to walk a half-hour each day when there is no safe place for them to walk?

Cities Changing Diabetes is a project that was begun by NovoNordisk and other partners looking for solutions. They understand that it takes more than one organization to attack this issue, so they are working with healthcare, non-profits, and social services organizations to combat the rise. It’s also important to note that rural areas have their own issues. Another time, another event.

My type of diabetes was not caused by race, weight, or sedentary lifestyle. (My beta cells left the pancreas party and never came back.) Type 2 diabetes is also not caused by race, weight, or sedentary lifestyle.

I don’t believe in the “You ate too much sugar and you are lazy. That’s why you have diabetes.” These can be contributing factors, but Type 2 diabetes is a metabolic disease that can, in many cases but not all, be prevented with small changes to every day life. (And more importantly, shaming and blaming individuals with Type 2 diabetes is also a cultural issue that needs addressing.)

How do we make a difference? Good question. I’m hoping for answers at this event and ways that I can help my diabetes community become healthier – and maybe prevent the community from growing larger. We’re a great group of people, but I’d like to keep it as exclusive as possible. The cost to enter this club is pretty expensive.

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1 comment

Christel, I love your questions. Here’s one more: Why only two patients on the panel, and why none with Type 2? Not that you and Kelly are not more than capable, because you are, but…

Also, I think what you’ve said here goes a lot to people coming up with solutions before they understand the problem fully. Hopefully, your discussion (guided in part by your questions) will move in that direction. Thanks for doing this for everyone living with diabetes.